Medications and the Sun

This article should instantly bring two key components of our profession to the forefront of awareness; first, UV exposure; second, thorough client consultation. Neither of which I would like to think are already not at the forefront of your daily practice, but if they are, this will most certainly change that. As an educator, a medical aesthetician, and one committed to the reputation of the aesthetics profession; the need and process of thorough consultation is a critical component of all that I do, and this article will help you understand why.

I have watched our profession emerge into one of knowledge, respect, prestige and necessity; all of which is the work of each and every on of you. However, along with each of the accolades comes great responsibility to our clients, ourselves and to our profession. I have watched the role of the professional aesthetician become one in which our clients come to us for direction, recommendations and the answers to their skin concerns; regardless of the environment that we work in. The “spa” aesthetician is no longer a “fluff and buff” skin person; but a true skin care expert.

As both consumer and professional awareness of the effects of the exposure to UV light on the aging process and skin cancers has quadrupled, so has the awareness of time spent in the sun and the daily application of sunscreen. Although critical for vitamin D production, the negative effects of UV light on the skin are well documented. There are a multitude of factors that influence the reaction of the skin to UV exposure at any given time; genetics, application of sunscreen, length of time in the sun, time of year, location in relationship to the equator (trust me, the tan you will get in upstate N.Y., U.S. and Cape Town, South Africa are surely two different tans.), exposure to chemical peels and surgical procedures, cosmetics and last, but not least, medications.

As modern science has advanced, so has the creation of life altering medications. Drugs that cure diseases, prolong lives, stabilize mood, regulate illnesses, and even those that simply aid in day to day psychological adaptation and living. As fortunate that society is for these amazing advancements and medications, it is increasingly critical to have an awareness of the side effects that they may have on the condition and reaction of the skin. This is our professional responsibility. Of the various effects that medications have on the skin, of greatest concern in increased photosensitivity.

Both topical and oral medication can result in increased photosensitivity = sun sensitivity. Photosensitivity is the inflammation of the skin caused by the combination of sunlight and sufficient amounts and types of substances or medications. Ultra violet wavelengths in the range of 320-400 nanometers are wavelengths that are more likely to cause photosensitive reactions, as I am sure you are all aware, these are categorized in the spectrum of UVA rays. However, on many occasions it has been noted that Ultraviolet wavelengths between 290-320 nanometers, UVB rays, can also trigger photosensitive reactions.

You will be surprised to discover that not only is the list of medications quite extensive, but medications for things that have absolutely nothing to do with the skin can increase the skins’ sensitivity to sunlight by as much as one hundred percent.

Categories of Photosensitizing Medications

Precautions should always be taken when a client is placed on a medication or a medication is changed. Below is a list of primary classes of typical photosensitizing medications. Within each class there are extensive examples which will require some effort on your part to become familiar with. My recommendation, always have a physicians desk reference on hand (PDR) to double check any medication a client may be on.

Tricyclic antidepressants – early forms of antidepressants used in the 1950s; since replaced by (Selective Serotonin Reuptake Inhibitors) SSRIs.

Examples of each class are noted below in relation to their types of photosensitive reactions. Photosensitive reactions are divided into two categories depending upon their manifestations, either phototoxic or photoallergic.

Phototoxic Reactions

Phototoxic reactions are acute reactions that appear much like a sunburn and are more prevalent than photoallergic reactions. They generally occur only in the sun exposed area of the body and are more intense in areas such as the face (especially the nose, cheeks and lips) and chest. In this type of reaction the drug is activated when it is exposed to UV light; the light activated drug compounds then effect cell membranes of the skin cells and in some instances, can affect cellular DNA.

Depending upon the type of medication, most phototoxic reactions require a relatively large amount, or high dose, of the medication to trigger the photosensitive response. However, they can also occur with the first use and exposure.

In many instances, the first thing that a client will experience is a burning, itching, stinging feeling on the skin. The sunburn look and redness of the reaction can appear within minutes of UV exposure to as much as 24 hours following the UV exposure. If you think about it, this is very much like an intense sunburn reaction; even after coming out of the sun, the most severe redness appears hours later into the evening. Depending upon the severity of phototoxicity the reaction may vary from mild erythema to more severe reactions such as edema, blistering and even hyperpigmentation in the effected area.

Phototoxic Medications

The list of medications can be quite lengthy; below I have created a list of medications that are more common and frequently documented on consultation forms. All of these are noted as increasing photosensitivity in individuals taking/using them.

Acne Medications

Isotretinoin

Tetracyclines

Antibiotics

Tetracyclines

Ciprofloxacin

Sulfonamides

Antidepressants

Tricyclic antidepressants (Desipramine, Imipramine)

Antihistamines

Diphenhydramine (Benadryl)

Cardiac Drugs

Amiodarone

Nifedipine

Quinidine

Chemotherapy medications

Dacarbazine

5-fluorouracil

Vinblastine

Diabetic medications

Chlorpropamide

Glyburide

Diuretics

Lasix

Photoallergic Reactions

Photoallergic reactions appear as a dermatitis-type reaction and are less prevalent than phototoxic reactions. They are more closely linked to topical medications than they are to systemic medications, and have a tendency to be more chronic (long lasting). A photoallergic reaction is a cell mediated immune response to a light activated compound. It is simply one more amazing way the human body and the skin works.

In this type of response the UV light actually alters the structure of the drug so that the body’s immune system identifies it as an antigen (a foreign substance). The presence of this antigen instantly triggers the skins natural inflammatory response of an allergic reaction; resulting in redness, swelling, itching and urticaria (hives).

Since this reaction behaves as an allergic reaction it may not occur with the first dose of medication and exposure to UV or may take several days to react. With subsequent UV exposures the response time diminishes and can be as rapid as hours to a day or two.

Depending on the type of mediation, most photoallergic reactions require a considerably smaller amount of drug to trigger an immune response. Interestingly enough, photoallergic reactions sometimes recur in the same location with future UV exposure, even after the medication has been cleared from the system. In some instances these reactions can even spread into areas of the skin that have not been exposed to UV light.

Photoallergic Medications

The list of phototoxic medications is a bit shorter, but can still be quite extensive. Below are some medications that are more commonly and frequently documented on consultation forms. All of these are noted as increasing photosensitivity in individuals taking/using them.

Anti-Microbials

Chlorhexidine (an antimicrobial mouthwash)

Hexachlorophene (an antibacterial cleanser)

Dapsone (anti-leprosy medication)

Chemotherapy Medications

5-fluorouracil

Painkillers

Celebrex (arthritis medication)

Sunscreens

Benzophenones

Cinnamate

Cyclohexanol

Oxybenzone

Salicylates

PABA

Sunscreens and fragrances are the most common topical allergy causing agents in the cosmetic industry. New technological advancements have greatly improved the quality and efficacy of the ingredients in conjunction with minimizing sensitivity.

Photosensitivity varies from person to person; and medication to medication. Not every client will react to the same medication in the same way, with the same manifestations or for the same length of time. It is also not a guarantee that an individual will have the same reaction with consecutive uses. A whole host of additional factors will also play a role in the degree of a photosensitive reaction, these include other medications being used, over all health, immune system health, amount of medication taken or used; and length of time it is prescribed for.

Another important factor to take into consideration is that medications that increase photosensitivity will often also increase overall skin sensitivity; especially to various forms of exfoliants such as enzymes, acids and microdermabrasion. It is very common for clients taking antihistamines during allergy season to have increased skin sensitivity to treatments that would otherwise not have any negative or sensitive effect on them. Common antibiotics for things such as bronchitis, strep throat or other seasonal illnesses are also critical triggers for heightened skin sensitivity. Clients taking any form of antibiotics or antihistamines should avoid chemical exfoliants and microdermabrasion during use and for at least five to 10 days following, depending upon the type and strength of antibiotic taken.

Due to the influence of both topical and medications on the skin, it is critical that through consultations are performed prior to every skin care service. A complete list of current medication use is a necessity. It is equally as important to review each clients consult form with every visit and make the appropriate changes to their medication use. Allergies medications, antibiotics for strep throat and bronchitis, and changes in birth control pills may seem very irrelevant to your clients. Because of this, clients may neglect to mention it, resulting in an unwanted reaction to what would otherwise be a normal skin treatment. It is our professional responsibility to integrate the consultation process into each and every pre-service protocol. This will also get our customers accustomed to the process so that they will also play an active role in consultation process.

The skin care business has morphed into a profession that operates at an amazing level of active ingredients, technological advancements and techniques that can alter the physiological health and functioning of the skin. This, is a gift, and provides the professional aesthetician with the ability to master the creation of individual treatment protocols to meet the needs and expectations of every client.

Our greatest challenge is to stay informed, to continue to learn and to raise the bar of the role of the professional aesthetician. As the awareness, needs and dedication of our client base has grown; so to, has our responsibility not only to our clients and profession, but to ourselves.

Michelle D’Allaird is a New York State licensed aesthetician and International CIDESCO Diplomat. She is the owner of the Aesthetic Science Institute aesthetic schools in Syracuse and Latham, N.Y. She is a consultant and educator for international cosmetic companies around the world. D’Allaird is a contributing author to major industry trade magazines, as well as a host and speaker for International Congress of Esthetics & Spa conferences in Miami, Philadelphia, Dallas, and Long Beach. She is also a co-author of Salon Fundamentals aesthetic textbook. Her expertise lies in education and curriculum development for aesthetic, medical, and laser courses.